Chapter 9 Use of Cancer Screening Practices by Hispanic Women

Written by Cati Bazan-Arias
Chapter 9: Use of Cancer Screening Practices by Hispanic Women,Analyses by Subgroup

Authors: Ruth E. Zambrana, Nancy Breen, Sarah A. Fox, Mary Lou Gutierrez-Mohamed, from “Latina Health in the United States” by Marilyn Aguirre-Molina & Carlos W. Molina, Jossey-Bass, a Wiley Imprint, 2003.

Synopsis: Using National Health Interview Survey data (1990-1992), the authors provide data on cancer screening (Pap smear, mammogram, and clinical breast examination [CBE]) among five Latina subgroups to determine the factors that influence the utilization of these screening services.

• In 1987, 13% of Hispanic women reported having mammogram vs. 18% non-Hispanic white women; in 1992 both rates doubled.
• Low income women, women over 65, and Hispanic women remain at the greatest risk of not being screened.
• Hispanic women represent 9% of the total female population in the U.S., expected to increase to over 15% by 2020.
• “Hispanics do not comprise a single coherent community. Rather, they are a disparate collection of national origin groups with heterogeneous experiences of settlement, immigration, political participation, and economic incorporation into the U.S.”.

Research shows that Hispanic women:

1. tend to be younger when diagnosed with breast or cervical cancer;
2. less likely to have visited a physician in the last year or to know cancer warning signs;

The underlying factors that place Hispanic women at risk are low-income status, lack of access to health care, and institutional barriers.

Screening is most strongly associated with knowledge of screening, prior screening, and physician recommendation for a screening.

For Hispanic women, acculturation, income, and education are three interrelated factors associated with health behaviors. English language is a principal marker of acculturation, and it is associated with country of birth, completed years of education, and number of years in the U.S.

The study by the authors found, among other results, that:

1. Screening rates are higher than might be expected among the Hispanic sample; it is inferred that recent intervention strategies, including increased public education and community outreach have been effective.
2. Not having a usual source of care lessens the likelihood of obtaining a screening recommendation from a physician; some physicians may not make recommendations due to cost concerns.
3. If physicians were to recommend preventive screening practices and refer patients to appropriate facilities and increase in use is expected.
4. Community-based health promotion activities have shown to increase cancer-screening practices among Hispanic women.
5. Successful interventions involve the Hispanic community members, use Spanish-language media (in particular public radio announcements), and existing community networks.
6. Social factors such as poverty rather than ethnicity alone should serve as the indicator of who needs health services. Ethnicity, defined as shared dynamic cultural identity, should be used to inform providers what and how services should be delivered.